| Model Number |
48004004X |
| Medical Device Problem Code |
Leak/Splash (1354)
|
| Health Effect - Clinical Code |
No Consequences Or Impact To Patient (2199)
|
| Date of Event |
09/21/2020
|
|
Type of Reportable Event
|
Malfunction
|
|
Additional Manufacturer Narrative
|
|
A review of the manufacturing documentation associated with lot (82182928) presented no issues during the manufacturing process that can be related to the reported event.Additional information is pending and will be submitted within 30 days upon receipt.
|
| |
|
Event or Problem Description
|
|
As reported, the balloon of a 4mm x 4cm x 150cm saber percutaneous transluminal angioplasty (pta) balloon catheter did not expand, and the air leaked out.There was no reported patient injury.The product was stored as per labeling.The device was opened in a sterile field.The device will be returned for evaluation.
|
| |
|
Additional Manufacturer Narrative
|
|
This device is available for analysis but the engineering report is not yet available.However, it will be submitted within 30 days upon receipt.
|
| |
|
Additional Manufacturer Narrative
|
|
Complaint conclusion: as reported, the balloon of a 4mm x 4cm x 150cm saber percutaneous transluminal angioplasty (pta) balloon catheter did not expand, and the air leaked out.There was no reported patient injury.The product was stored as per labeling.The device was opened in a sterile field.The product was returned for analysis.A non-sterile saber 4mm x 4cm 150 was received for analysis coiled inside a plastic bag.Per visual analysis, the balloon looks like it has been previously inflated.A kink was observed on the body/shaft of the catheter.No other anomalies were observed.Per functional analysis, balloon inflation was performed.A lab inflator/deflator device was attached to the inflation lumen of unit and pressure applied.A leakage of water was observed coming from the distal area of the balloon.Per sem analysis on the balloon leakage observed during the functional test, results showed that the balloon leakage was caused by a rupture on the balloon surface.The inner surface presented no anomalies near the balloon rupture.The outer surface presented evidence of scratch marks near the balloon rupture.This type of damage is commonly caused during the interaction of the balloon material with a sharp object or mechanical damage.It is very likely that the same factors that caused the observed scratch marks on the balloon outer surface could probably led to the rupture condition found on the received device.It seems the balloon material near the rupture was torn either due to the interaction of the balloon with calcified spicules located on the lesion or with a sharp object from the outside of the balloon.No other anomalies were observed during the sem analysis.A product history record (phr) review of lot 82182928 revealed no anomalies or non-conformances during the manufacturing and inspection processes that can be associated with the reported event.The reported ¿balloon leakage - during positive pressure¿ was confirmed via device analysis as a leakage of water was noted during functional analysis.However, the exact cause cannot be determined.Device analysis revealed scratch marks on the balloon surface near the rupture.It is likely vessel characteristics contributed to the reported event as evidenced by the results provided.The balloon material near the rupture appears to have been torn either due to the interaction of the balloon with calcified spicules located on the lesion or with a sharp object from the outside of the balloon.According to the warnings in the safety information in the instructions for use ¿prior to angioplasty, the catheter should be examined to verify functionality and integrity, and ensure that its size and shape are suitable for the specific procedure for which it is to be used.Do not use if product damage is suspected or evident.To reduce the potential for vessel damage or the risk of dislodgement of particles it is very important that the inflated diameter of the balloon should approximate the diameter of the vessel just proximal and distal to the lesion.The balloon dimensions are printed on the product label.The compliance table incorporated with the product shows how balloon diameter increases as pressure increases.Do not exceed the rated burst pressure recommended on the label.The rated burst pressure is based on the results of in vitro testing.At least 99.9% of the balloons (with a 95% confidence) will not burst at or below their rated burst pressure.Use of a pressure monitoring device is recommended to prevent over-pressurization.Pressure in excess of the rated burst pressure can cause balloon rupture and potential inability to withdraw the catheter through the introducer sheath.Balloon rupture can cause vessel damage and the need for additional intervention.Use only the recommended balloon inflation medium (a 50/50 mixture by volume of contrast medium and normal saline).Never use air or any gaseous medium to inflate the balloon.¿ neither the phr nor the information available suggests a design or manufacturing related cause for the reported event.Therefore, no corrective or preventive action will be taken at this time.
|
| |
|
Search Alerts/Recalls
|